title: Understanding the disparity: predictors of virologic failure in women using highly active antiretroviral therapy vary by race and/or ethnicity.
abstract: BACKGROUND
  Stark racial/ethnic disparities in health outcomes exist among those living with HIV in the United States. One of 3 primary goals of the National HIV/AIDS Strategy is to reduce HIV-related disparities and health inequities.
  
  
  METHODS
  Using data from HIV-infected women participating in the Women's Interagency HIV Study from April 2006 to March 2011, we measured virologic failure (HIV RNA >200 copies/mL) after suppression (HIV RNA < 80 copies/mL) on highly active antiretroviral therapy. We identified predictors of virologic failure using discrete time survival analysis and calculated racial/ethnic-specific population-attributable fractions (PAFs).
  
  
  RESULTS
  Of 887 eligible women, 408 (46%) experienced virologic failure during the study period. Hispanic and white women had significantly lower hazards of virologic failure than African American women [Hispanic hazard ratio, (HR) = 0.8, 95% confidence interval: (0.6 to 0.9); white HR = 0.7 (0.5 to 0.9)]. The PAF of virologic failure associated with low income was higher in Hispanic [adjusted hazard ratios (aHR) = 2.2 (0.7 to 6.5), PAF = 49%] and African American women [aHR = 1.8 (1.1 to 3.2), PAF = 38%] than among white women [aHR = 1.4 (0.6 to 3.4), PAF = 16%]. Lack of health insurance compared with public health insurance was associated with virologic failure only among Hispanic [aHR = 2.0 (0.9 to 4.6), PAF = 22%] and white women [aHR = 1.9 (0.7 to 5.1), PAF = 13%]. By contrast, depressive symptoms were associated with virologic failure only among African-American women [aHR = 1.6 (1.2 to 2.2), PAF = 17%].
  
  
  CONCLUSIONS
  In this population of treated HIV-infected women, virologic failure was common, and correlates of virologic failure varied by race/ethnicity. Strategies to reduce disparities in HIV treatment outcomes by race/ethnicity should address racial/ethnic-specific barriers including depression and low income to sustain virologic suppression.
authors.affiliation: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; ‡Department of Community Health Sciences, State University of New York Downstate Medical Center, Brooklyn, NY; §Department of Medicine, Georgetown University Medical Center, Washington, DC; ‖Department of Medicine, University of California San Francisco, San Francisco, CA; ¶Department of Medicine and the CORE Center, Cook County Health and Hospitals System, Chicago, IL; and #Rush University, Chicago, IL.
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
authors.forename: Carla E
authors.initials: CE
authors.lastname: Zelaya
authors.forename: Kerry
authors.initials: K
authors.lastname: Murphy
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
authors.forename: Mary A
authors.initials: MA
authors.lastname: Young
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load / Q000187:drug effects; D044465:White People / Q000706:statistics & numerical data*; D016387:Women's Health / Q000208:ethnology*; D016903:Drug Monitoring